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Plastic Surgery: The Naked Truth about the Four Dimensions of Facial Rejuvenation

Published on January 11, 2017 by

Dr.Horowitz_Profile_PictureThere are really four dimensions for facial rejuvenation, the fourth being time, making you look ten years younger. The other dimensions that must be addressed to reach the fourth dimension of time include: tightening loose structures such as muscle and skin; correcting and adding volume; and treating the surface of the skin. It’s great that we have so many surgical and non-surgical options, many of which did not exist even a few short years ago.

The best results will come from a combination of these treatments which can often be performed at the same time. It’s key during your consultation for the doctor and treating nurses and skin care specialists to properly evaluate your needs and desires in order for us to offer you the best customized package that will allow you to achieve your goals.

The first dimension is tightening the loose structures of the face and neck. The LiteLift® is our Short Incision Vertical Facelift that I developed around 2008 (https://www.youtube.com/watch?v=6tZ57kDXz_k) and have since popularized this technique, performing hundreds of cases each year. We were looking for a quicker, simpler, less invasive facelift procedure that patients could recover from sooner and be done with simpler anesthesia including local in our office procedure room. We are able to tighten the neck, jawline , mid face (cheeks) with a natural appearance that is long lasting. We tighten the muscle in the same manner as a traditional lift and this procedure is adequate for 90% of our patients seeking treatment of these areas. So this treats the first dimension: laxity and excess of skin and muscle.

The second dimension is volume. As we age, the volume of our bones, muscle, and fat which support the overlying skin will change. This makes our eyes and temples look hollow. Our cheeks become flat and our face less heart shaped and more oval or rectangular with widening of the lower half. We gain fullness in our jowels and excess fat under the neck. We develop folds of skin in the nasolabial area and “marrionette” lines. Our lips become long but thin. Luckily, there are many choices to improve these areas. Fillers run the gamut from HAs (hyaluronic acids, the building blocks of our body) to Sculptra®, which stimulates new collagen development over time. We have your own natural fat and now there is Allofil, a manufactured fat that can be used off the shelf. Radiesse, Bellafil and many others have unique properties that allow us to choose the best product for the location that is being corrected. Many of these fillers appear to perform better when the surrounding surface is tighter.

The third dimension is the skin itself. Young, healthy skin is clear, bright, smooth, without excess redness, brown or spots and moles. There is an actual luminosity to the skin. There is a minimum of static lines and creases and a modest amount of dynamic smile lines , cheek lines, brow crease, chin cobble stoning and so forth. The options here are wide and varied. Chemical peels and laser treatments of various types can go a long way to the desired changes. Fotofacial treatments with IPL or Broad Band Light can actually make the skin physically younger over time by changing the cellular structure. We can diminish cancerous and pre-cancerous skin changes. Botox and other medications that freeze the facial muscles diminish the unwanted lines noted above leaving us looking more youthful, less tired and angry. Different energy sources can tighten the skin, enhance the results of a lift and help long term maintenance of a lift. These include the proper use of ultrasound and radio frequency energy sources that tighten the underlying collagen. Examples include: Ultherapy, thermage, thermismooth and RF microneedling. For younger patients with tighter, healthier skin, surgery can be completely bypassed using only the non-surgical modalities noted above.

These treatments leave us to the Fourth Dimension, the dimension of time and turning the clock back five, ten, or even fifteen years for some patients. So why do our patients want these cosmetic enhancements? Almost ninety percent of the patients asked this question in one survey wanted to either look younger or look better. Men in the survey also were motivated by looking good and staying competitive in the work place as well as socially.